Power Up USA Camp Registration Form
This Camp is Free, But to book for a place in the the camp, you must complete the form below accurately and pay a $29.00 Registration Fee.
Your Name
First Name
Last Name
Birth Date
Please select a month
January
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Month
Please select a day
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Day
Please select a year
2025
2024
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Year
Home Phone Number
Mobile Number
Email Address
example@example.com
Desired Name Tag
Primary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select Camp shirt size
Small
Medium
Large
Extra-large
Please provide any medical or dietary restrictions you have
How did you hear about Camp?
Please Select
Email
Social Media
Print Ads
Radio
Referral
School Official
Others
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Please answer how you identify
African American
Asian American
Caucasian American
Latino American
Other
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Please Read
By submitting this form, the applicant and his/her guardian understand and accept the following terms and conditions of the Camp herein provided: 1. Parents must be aware that camp will be on a first come first served basis. 2. The payment of the deposit enrolls the camper to the selected period of the camp program. 3. Should the camper withdraw anytime within the period of the scheduled camp which the camper enrolled, he/she shall not receive any refund. 4. All medical conditions of the camper must be stated on the application form in a concise and clear manner. 5. Campers when in camping activity must bring the recommended gear for the specific trip that shall be required by the camp counselor. 6. The camper should bring his own rain gear and sun block cream upon admission to the camp. The rest shall be provided by the Camp. 7. Any activity outside or not part of the camp's program shall not hold the Camp's employees responsible for anything that might happen to the campers. 8. The camp shall not accept responsibility for the loss or damage to any property belonging to the campers. 9. The camp reserves the right to cancel part of/or the entire program. 10. Cameras are permitted provided that it does not contain any communication feature via internet or mobile phone services. Photographs and videos are allowed to be taken as long as it will not disturb the activity for the benefit of other campers. 11. The camp's staff may take photos or videos while in the camp's activities and may use such photos or videos for promotional purposes. However, if you do not wish images of your camper to be used by us. Please inform us anytime. 12. The guardian authorizes the Camp to seek medical treatment in the event of an accident or sickness. It is likewise the Camp's responsibility to inform the parents/guardians of the camper in case such event arises at the earliest time possible for the Camp's staff to inform the parents or guardians. 13. The schedule of activities are subject to change depending on weather conditions, program schedule and other arrangements by which the Camp reserves the right to cancel, amend or alter activities accordingly in the event of unanticipated situations.
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School Information
School Name
Year in School
Please Select
Elementary
Middle School
Freshman (9th)
Sophomore (10th)
Junior (11th)
Senior (12th)
Current GPA
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Family Information
Parent/Guardian's Name
First Name
Last Name
Contact Phone Number
E-mail Address
example@example.com
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Emergency Contact Information
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Relationship to Student
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Your Reason For Attending This Camp
In 300 words or less, please describe your reasons for wishing to attend this camp.
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Power Up Application Fee
Th Power Up USA Camp is free but a $29.00 registration fee is require to secure your spot.
$
29.00
Quantity
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Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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